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    <recommendedItem id="20100101_19_433"
                     title="Household Routines Linked to Lower Childhood Obesity (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/Pediatrics/Parenting/tb/18340?impressionId=1265793097759"
                     
      &lt;p&gt;Want to protect your preschooler from obesity?&lt;/p&gt;
&lt;p&gt;Eat dinner as a family six or seven times a week, limit the time the child watches TV to less than two hours a day, and make sure he or she gets more than 10.5 hours of sleep a night.&lt;/p&gt;
&lt;p&gt;Those three simple household routines are associated with an&lt;strong&gt; &lt;/strong&gt;almost 40% reduction in the risk of childhood obesity, according to Sarah Anderson, PhD, of Ohio State University College of Public Health in Columbus, and Robert Whitaker, MD, of Temple University in Philadelphia.&lt;/p&gt;
&lt;p&gt;The association remained significant even in the face of other predictors of childhood obesity, such as maternal obesity or being in a single-parent family, the authors said in the March issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;I imagine people are going to want to know which of the routines is most important: Is it limited TV, is it dinner, is it adequate sleep?&quot; Anderson said in a statement.&lt;/p&gt;
&lt;p&gt;&quot;What this suggests is that you can&apos;t point to any one of these routines,&quot; she said. &quot;Each one appears to be associated with a lower risk of obesity, and having more of these routines appears to lower the risk further.&quot;&lt;/p&gt;
&lt;p&gt;The findings are based on data collected in 2005 on 8,550 children born in the U.S. in 2001 who were part of the Early Childhood Longitudinal Study, Birth Cohort.&lt;/p&gt;
&lt;p&gt;For the study, the 4-year-olds were considered to be obese if they were at or above the 95th percentile in weight for their age and sex.&lt;/p&gt;
&lt;p&gt;Overall, the authors reported, 18% of children were obese by that measure.&lt;/p&gt;
&lt;p&gt;The researchers found that 14.5% of the children in the study lived in families where all three of the routines were observed, and 12.4% in families where none took place.&lt;/p&gt;
&lt;p&gt;Among children exposed to all three, 14.3% were obese, compared with 24.5% among those exposed to none of the routines, they found.&lt;/p&gt;
&lt;p&gt;In a multivariate analysis, children used to all three routines had an odds ratio for obesity of 0.63, compared with those who were exposed to none, the researchers found. (The 95% confidence interval was 0.46 to 0.87.)&lt;/p&gt;
&lt;p&gt;Any two routines, again compared with none, had an odds ratio for obesity of 0.64, with a 95% confidence interval from 0.47 to 0.85.&lt;/p&gt;
&lt;p&gt;A similar pattern was seen for one routine compared with none, but in the multivariate analysis the benefit was no longer statistically significant.&lt;/p&gt;
&lt;p&gt;However, in a univariate analysis, any single routine, compared with none, reduced the odds of obesity by between 23% and 25%, the authors found, and the odds did not change much when the presence or absence of the other two was factored in.&lt;/p&gt;
&lt;p&gt;That finding suggests an &quot;independent association of each routine with obesity,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;The study is limited by elements of its design, the researchers said. The study was unable to account for differences in diet or physical activity, and the prevalence of the three routines was assessed by parent report, which might have introduced bias.&lt;/p&gt;
&lt;p&gt;Information on types of foods served, how many people were present at dinner, concomitant television viewing along with the meal, advertising viewed on television, and quality of sleep was not available.&lt;/p&gt;
&lt;p&gt;They also noted that the study is cross-sectional and can&apos;t be used to establish any causal relations between the three routines and obesity.&lt;/p&gt;
&lt;p&gt;Nonetheless, they concluded, the three routines &quot;may be promising behavioral targets for counseling, given their association with obesity and their potential benefits beyond obesity prevention.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the U.S. Department of Agriculture.&lt;/p&gt;&lt;p&gt;The authors said they had no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_261"
                     title="Scrubbing Away Germs Can Backfire on Backsides (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/18121?impressionId=1265793097759"
                     
      Rashes from toilet seats are once again afflicting American children, and the rare condition is often misdiagnosed, which may delay proper treatment.&lt;br&gt;
&lt;br&gt;That&apos;s the conclusion from a report based of five-cases of toilet-seat contact dermatitis investigated by researchers at Johns Hopkins University School of Medicine and reported in the Jan. 25 issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;While toilet-seat dermatitis is commonly thought to result from allergies to wooden seats, the report concludes that another source is plastic toilet seats cleaned with harsh detergents.&lt;/p&gt;
&lt;p&gt;&quot;This case series and previous reports have documented that toilet-seat dermatitis is much more common than previously recognized in the U.S. and around the world,&quot; Bernard A. Cohen, MD, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;Furthermore, the incidence of this condition is rising in North America because of a resurgent popularity of exotic-wood toilet seats and frequent use of detergents that contain highly irritant/sensitizing compounds such as quaternary ammonium compounds, phenol, formaldehyde, etc. in public restrooms.&quot;&lt;/p&gt;
&lt;p&gt;Of the cases analyzed by the authors, two occurred in the U.S. and the other three occurred in India.&lt;/p&gt;
&lt;p&gt;Both U.S. cases were girls, a 6-year-old who had a rash for over two years before it was correctly diagnosed and a 10-year-old whose rash lasted for a year. In both cases, the rashes seemed to worsen during the school year when the girls were using school restrooms. The younger girl&apos;s dermatitis twice became infected with methicillin-resistant &lt;em&gt;Staphylococcus aureus &lt;/em&gt;and required treatment with antibiotics.&lt;/p&gt;
&lt;p&gt;After doctors determined the rashes were the result of contact with toilet seats and instructed the girls to use toilet-seat covers and apply moisturizers and topical steroids to the affected areas, the eruptions cleared up within a few weeks.&lt;/p&gt;
&lt;p&gt;The cases in India included a 14-month old boy and two girls, 12 and 10.&lt;/p&gt;
&lt;p&gt;The boy and the 12-year-old girl were both initially misdiagnosed with ringworm and unsuccessfully treated with clotrimazole cream. The other girl was unsuccessfully treated with ayurvedic and homeopathic topical medications before doctors diagnosed toilet-seat dermatitis. Two of the children were instructed to use soaps that only exacerbated the problem.&lt;/p&gt;
&lt;p&gt;In all three cases, the rashes cleared up with some combination of topical steroids, using toilet-seat covers, replacing the household toilet seat, and limiting time on the toilet.&lt;/p&gt;
&lt;p&gt;The authors distinguished between two types of toilet-seat dermatitis: allergic contact dermatitis, the better described form of the condition, in which a patient develops allergy to wooden toilet seats, and irritant contact dermatitis, in which the rashes result from contact with harsh detergents used on plastic toilet seats.&lt;/p&gt;
&lt;p&gt;They noted that detergents used in public restrooms and in hospitals are potentially more irritating to the skin than those used at home and that alkaline detergents are more likely to cause skin irritation than acidic detergents, because they perturb the body&apos;s natural acidic environment.&lt;/p&gt;
&lt;p&gt;Toilet-seat dermatitis was first identified as an external skin rash in 1927. Exposure to wooden toilet seats and associated varnish, lacquers, and paints led to sensitization and development of an allergic contact dermatitis.&lt;/p&gt;
&lt;p&gt;The condition nearly disappeared in the U.S. in 1980s and 1990s, after public facilities and homeowners in the U.S. changed from wooden to plastic toilet seats and sanitary seat covers became readily available.&lt;/p&gt;
&lt;p&gt;However, in recent years the number of cases has grown as a result of homeowners installing toilet seats made of exotic woods and the increased use of harsh toilet seat detergents.&lt;/p&gt;
&lt;p&gt;Most reports have focused on adults with rashes, but little previous attention has focused on the condition in children. &quot;In this case series we describe toilet-seat contact dermatitis in children and underscore a typical history and physical findings that we hope will aid clinicians in recognizing this disease,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;It is important to underscore that regular use of toilet-seat covers is the key to success in treatment,&quot; the authors wrote. &quot;Such seat covers can be purchased at any major retailer such as Walmart or online.&lt;/p&gt;
&lt;p&gt;As an alternative, newspaper cutouts could be used to provide barrier protection. Although it is possible to develop an allergy to toilet-seat covers, none have been reported thus far in the literature.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported no sources of funding or financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_202"
                     title="Survival Rates Vary with Congenital Anomalies (CME/CE)"
                     score="-0.002"
                     href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/18035?impressionId=1265793097759"
                     
      &lt;p&gt;Survival among children with congenital anomalies has increased in recent decades, but still varies notably depending on the condition, a British study found.&lt;/p&gt;
&lt;p&gt;Overall 20-year survival was 85.5% (95% CI 84.8 to 86.3) among children born with at least one congenital anomaly, Peter W.G. Tennant, MsC, of Newcastle University, and colleagues reported online in &lt;em&gt;Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;For specific conditions, the 20-year survival rates were as follows: &lt;ul&gt; &lt;li&gt;Orofacial clefts, 97.6% (95% CI 95.9 to 98.6)&lt;/li&gt; &lt;li&gt;Urinary system, 93.2% (95% CI 91.6 to 94.5)&lt;/li&gt; &lt;li&gt;Cardiovascular system, 89.5% (95% CI 88.4 to 90.6)&lt;/li&gt; &lt;li&gt;Digestive system, 83.2% (95% CI 79.8 to 86)&lt;/li&gt; &lt;li&gt;Chromosomal anomalies, 79.1% (95% CI 76.6 to 81.3)&lt;/li&gt; &lt;li&gt;Nervous system, 66.2% (95% CI 61.5 to 70.5)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Congenital anomalies are recognized as a major cause of perinatal and infant mortality, but little is known about longer-term survival with conditions other than Down syndrome or spina bifida.&lt;/p&gt;
&lt;p&gt;So Tennant and colleagues analyzed data from the Northern Congenital Abnormality Survey, which is a population-based register for the north of England.&lt;/p&gt;
&lt;p&gt;Their study included 13,758 cases of congenital anomaly reported to the registry between January 1985 and December 2003, representing a prevalence of 20.8 per 1,000 births.&lt;/p&gt;
&lt;p&gt;Among these, 0.9% were late miscarriages, 16.3% were terminations after prenatal diagnosis, 3.1% were stillbirths, and 79.7% were live births.&lt;/p&gt;
&lt;p&gt;Of the 10,850 liveborn cases for whom survival status was known, 1,465 (13.5%) died during the course of the study.&lt;/p&gt;
&lt;p&gt;Year of birth was a highly significant predictor of survival, (HR 0.92, 95% CI 0.92 to 0.93, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001), which likely relates to important medical and surgical advances such as surfactant therapy and corticosteroid use for respiratory distress syndrome, as well as intrapartum treatment for chorioamnionitis.&lt;/p&gt;
&lt;p&gt;The rate of termination for fetal anomaly increased over time, rising from 12.4% (95% CI 9.8 to 15.5) in 1985 to 18.3% (95% CI 15.6 to 21.2) in 2003.&lt;/p&gt;
&lt;p&gt;The investigators further analyzed survival among specific subtypes of anomalies and found rates of 20-year survival exceeding 95% for the following: &lt;ul&gt; &lt;li&gt;Ventricular septal defects, 98.3% (95% CI 96.6 to 99.1)&lt;/li&gt; &lt;li&gt;Pulmonary valve stenosis, 98.1% (95% CI 96.1 to 99.1)&lt;/li&gt; &lt;li&gt;Cleft lip and palate, 97.7% (95% CI 94.6 to 99.1)&lt;/li&gt; &lt;li&gt;Atrial septal defects, 96.3% (95% CI 93.3 to 98)&lt;/li&gt; &lt;li&gt;Cleft palate, 96.3% (95% CI 92.8 to 98.1)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;In contrast, subtypes with less than 50% one-year survival included arhinencephaly/holoprosencephaly, common arterial trunk, and hypoplastic left heart.&lt;/p&gt;
&lt;p&gt;Previous studies have found ten-year survival rates ranging from 76.5% to 88.6% for Down syndrome, 80.9% for all phenotypes of spina bifida, and 64% for spina bifida with hydrocephalus.&lt;/p&gt;
&lt;p&gt;In this study, the ten-year survival for Down syndrome was 83.9%, which probably reflects differences in care over time and by location, as well as surgical management and changing rates of terminations.&lt;/p&gt;
&lt;p&gt;The ten-year survival for spina bifida without hydrocephalus was 86.7% but fell to 53.3% with hydrocephalus, and 20-year survival remained 36.7% lower in those having hydrocephalus (95% CI 24 to 40, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).&lt;/p&gt;
&lt;p&gt;Previous estimates of survival among children with cardiovascular anomalies ranged from 74.7% to 76.9% at five years, which are substantially lower than the 91.1% reported in the present study.&lt;/p&gt;
&lt;p&gt;As with Down syndrome, this may represent advances in care, but also may reflect the fact that the investigators stratified cases according to the presence of multiple anomalies.&lt;/p&gt;
&lt;p&gt;&quot;This effect is inconsequential for primary anomalies with a high mortality rate, such as hypoplastic left heart syndrome, since the effect of the primary anomaly is likely to overwhelm the effect of any additional anomalies. However, as the severity of the primary anomaly decreases, the confounding effect of any additional anomalies is likely to increase,&quot; they explained.&lt;/p&gt;
&lt;p&gt;For example, the 20-year survival of 98.3% for ventricular septal defect would have fallen to 91.7% if multiple anomalies had not been classified separately.&lt;/p&gt;
&lt;p&gt;The biggest limitation of the study was that only 10% of patients were born twenty years before the matching date of the study (Jan. 28, 2008) so that 20-year survival rates were only estimates for most of the anomaly subtypes.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, David H. Stone, MD, of the University of Glasgow, called for more research and funding for congenital anomalies.&lt;/p&gt;
&lt;p&gt;&quot;Birth-defect registries have had a chequered history since their initial proliferation after the thalidomide disaster,&quot; he wrote.&lt;/p&gt;
&lt;p&gt;They are a crucial source of data, but face an endless struggle for funding, with the result that good quality data on etiology, prevalence, and outcomes are sparse.&lt;/p&gt;
&lt;p&gt;&quot;The publication of today&apos;s findings from the north of England should provide a much-needed boost to the cause of congenital anomaly surveillance,&quot; Stone concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Funding for the study was provided by BDF Newlife.&lt;/p&gt;&lt;p&gt;All investigators and the editorialist declared no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_170"
                     title="Gov&apos;t Touts BPA Research Effort"
                     score="-0.003"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/tb/18005?impressionId=1265793097759"
                     
      Federal health officials said the government will spend $30 million on research to pin down health risks associated with bisphenol A (BPA), a chemical used to soften plastics in baby bottles, cups, and plastic packaging that has come under increasing scrutiny in recent years.&lt;br&gt;
&lt;br&gt;William Corr, deputy secretary of Health and Human Services (HHS), told reporters in a press call that the agency was investing the money in &quot;short- and longer-term studies&quot; to provide better guidance on the safety of BPA in infant food containers.&lt;br&gt;
&lt;br&gt;Most of the funding will pass through the National Institute of Environmental Health Sciences. Its director, Linda Birnbaum, PhD, said $15 million in economic stimulus money had been earmarked for BPA studies, on top of $15 million in the agency&apos;s existing research portfolio.&lt;/p&gt;
&lt;p&gt;Corr also announced plans to form an interagency task force to address the general topic of environmental health risks to children, though he provided no details.&lt;/p&gt;
&lt;p&gt;Studies have shown that BPA can mimic the action of female reproductive hormones and may be linked to cardiovascular disease, diabetes, and liver abnormalities. Infants&apos; exposure is a particular concern because they may be more sensitive to these effects than adults.&lt;/p&gt;
&lt;p&gt;Corr noted that HHS has posted a list of manufacturers who have assured the FDA that they have not used BPA in baby bottles and infant feeding cups manufactured since January 2009. These include Avent, Doctor Brown&apos;s Natural Flow, Evenflow, First Essentials, Gerber, Munchkin, Nuk, and Playtex. Together, these firms account for more than 90% of the U.S. market, according to HHS.&lt;/p&gt;
&lt;p&gt;FDA Commissioner Margaret Hamburg, MD, said in the press call that the agency now accepts that BPA is of &quot;some concern&quot;  --  words she emphasized repeatedly.&lt;/p&gt;
&lt;p&gt;They&apos;re a quote from a 2008 report by the National Toxicology Program, part of the National Institutes of Health (and also directed by Birnbaum). The toxicology program report appeared to contradict the FDA&apos;s own 2008 assessment that BPA was acceptably safe.&lt;/p&gt;
&lt;p&gt;The FDA evaluation, which relied on published studies, drew withering criticism from Congress and the agency&apos;s own science advisory board. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/11568&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/11568&quot; target=&quot;_blank&quot;&gt;FDA Spanked by Full Science Board on Bisphenol A Safety Stance&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Hamburg said the National Toxicology Program analysis used different methods and outcomes than the FDA&apos;s initial review. She stopped short of repudiating the FDA assessment, but said the agency shared the National Toxicology Program&apos;s conclusions.&lt;/p&gt;
&lt;p&gt;She said the FDA was also performing its own studies of BPA, cooperating with the National Institutes of Health on research expected to wind up in 18 to 24 months.&lt;/p&gt;
&lt;p&gt;The FDA is also working with manufacturers to change product designs to eliminate BPA and, where necessary, to remove BPA-containing products from the market, Hamburg said.&lt;/p&gt;
&lt;p&gt;Both Hamburg and Corr emphasized that parents should not change their infants&apos; feeding regimes based on potential risks from BPA.&lt;/p&gt;
&lt;p&gt;&quot;Good nutrition outweighs any risk from exposure to BPA,&quot; Corr said, though he noted that breastfeeding is preferred for infants in any case.&lt;/p&gt;
&lt;p&gt;Corr also outlined four recommendations for parents of infants: &lt;ul&gt; &lt;li&gt;Follow published recommendations for infant feeding, starting with breastfeeding&lt;/li&gt; &lt;li&gt;Avoid scratched or torn bottles, as these are more likely to release BPA into foods&lt;/li&gt; &lt;li&gt;Don&apos;t put boiling liquids into infant bottles, for the same reason&lt;/li&gt; &lt;li&gt;Put food containers into microwave ovens or dishwashers only if the labels indicate that they&apos;re safe for such environments&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The FDA is also continuing to study the safety of BPA in medical devices. (See &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/13022&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/13022&quot; target=&quot;_blank&quot;&gt;FDA to Test BPA Exposure from Medical Devices&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;However, in the press call, Hamburg and her deputy, Joshua Sharfstein, MD, declined to answer questions about the status of this effort. Sharfstein said they were only prepared to talk about food containers at this point.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_3_172"
                     title="Car Safety Seats May Cause Breathing Problems for Infants"
                     score="-0.005"
                     href="